Brannan J D, Koskela H, Anderson S D, Chew N
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.
Am J Respir Crit Care Med. 1998 Oct;158(4):1120-6. doi: 10.1164/ajrccm.158.4.9802087.
We investigated airway responsiveness to mannitol, a new hyperosmolar challenge, in persons hyperresponsive to airway drying. We studied 36 asthmatic subjects, 18 to 40 yr of age, responsive to exercise (n = 23) and eucapnic hyperventilation (n = 28) defined by a 10% fall in FEV1. Fifteen subjects performed both challenges. All subjects performed a challenge with dry powder mannitol, encapsulated and delivered via a Dinkihaler until a 15% decrease in FEV1 was documented or a cumulative dose of 635 mg was delivered. All subjects responsive to eucapnic hyperventilation and all but one subject responsive to exercise were responsive to mannitol. Sixty-nine percent of subjects had a positive response to mannitol after less than 155 mg (6 capsules) and 94% less than 320 mg (10 capsules). The provoking dose of mannitol required to cause a 15% fall in FEV1 (PD15) was related to the severity of the response to exercise (Pearson's correlation coefficient [rp] = 0.68, p < 0.01) and eucapnic hyperventilation (rp = 0.68, p < 0.01) in subjects who were not taking inhaled corticosteroids. The mean (+/- SD) maximum percent fall in FEV1 after mannitol was 24.4 +/- 6.2% and recovery to bronchodilator occurred within 10 min in most subjects. The mannitol test is simple, inexpensive, faster to perform than hyperpnea with dry air and could become an office-based test. Further studies are now required to determine the sensitivity of mannitol to identify exercise-induced asthma in a random population.
我们研究了气道对甘露醇（一种新的高渗激发物）的反应性，该研究针对气道对干燥敏感的人群。我们研究了36名年龄在18至40岁之间的哮喘患者，其中23名对运动有反应，28名对等容性过度通气有反应（定义为FEV1下降10%）。15名受试者进行了两种激发试验。所有受试者均使用通过Dinkihaler封装并递送的干粉甘露醇进行激发试验，直至记录到FEV1下降15%或递送累积剂量达635 mg。所有对等容性过度通气有反应的受试者以及除一名受试者外所有对运动有反应的受试者均对甘露醇有反应。69%的受试者在摄入少于155 mg（6粒胶囊）的甘露醇后出现阳性反应，94%的受试者在摄入少于320 mg（10粒胶囊）后出现阳性反应。在未使用吸入性糖皮质激素的受试者中，导致FEV1下降15%所需的甘露醇激发剂量（PD15）与对运动（Pearson相关系数[rp]=0.68，p<0.01）和等容性过度通气（rp=0.68，p<0.01）的反应严重程度相关。甘露醇激发试验后FEV1的平均（±标准差）最大下降百分比为24.4±6.2%，大多数受试者在10分钟内恢复到支气管扩张剂状态。甘露醇试验简单、廉价，比干燥空气过度通气试验执行速度更快，且可成为一种基于门诊的检查方法。现在需要进一步研究以确定甘露醇在随机人群中识别运动诱发哮喘的敏感性。
